Study suggests new approach to OD-reversing drug

Pharmacies should proactively offer the overdose-reversing drug naloxone to help put it in the hands of people at risk of abusing opioids, according to a recent Boston Medical Center study.

Gerry Tuoti Wicked Local Newsbank Editor

Pharmacies should proactively offer the overdose-reversing drug naloxone to help put it in the hands of people at risk of abusing opioids, according to a recent Boston Medical Center study.

The study, which was published last month in the Journal of the American Pharmacists Association, found that while naloxone is available without a prescription at Massachusetts pharmacies, patients and their loved ones are reluctant to ask for it due to the stigma that surrounds addiction. Additionally, pharmacists may be reluctant to bring up the subject out of fear of offending patients.

The Boston Medical Center researchers worked with focus groups of people taking prescription opioids for chronic pain management, recovering addicts, family members of addicts and pharmacists.

“The idea of universally offering it was attractive to all the groups,” said epidemiologist Traci Green, the study’s lead author and associate director of the Injury Prevention Center at Boston Medical Center. “This makes it a less-stigmatizing interaction at the pharmacy.”

Last year, there were 1,465 confirmed opioid-related deaths in Massachusetts, according to the Department of Public Health. As many as 562 suspected opioid-related deaths are still under review and could be added to the 2016 total.

While the Boston Medical Center study found support for a proactive, universal opt-out policy for offering naloxone, it’s still not clear what such a policy could look like. Green explained one option could be instructing pharmacists to offer naloxone to everyone with a long-term opioid prescription. Another option could make it a policy to also offer naloxone to patients with a prescription history or combination of prescriptions that indicates they’re at a higher risk of addiction.

Since pharmacies are a major source of syringes for many opioid addicts, pharmacies could also implement a policy of automatically offering naloxone to anyone requesting syringes.

“Most of the fatal overdoses have been fentanyl-involved, and not prescribed fentanyl,” said Jared Owen, communications director for the Massachusetts Organization for Addiction Recovery. “Rather than people getting prescription opioids and overdosing on them, it’s really the people using the illicit drugs.”

Focusing on getting naloxone into the hands of people going to pharmacies for syringes could be more effective and less cost-prohibitive than providing the anti-overdose medication to prescription opioid patients who are at a lower risk of overdosing, he said.

Naloxone, which can cost up to $70 for a dose, is covered by MassHealth.

MOAR and other addiction recovery groups have asked for $1 million in the state budget to provide naloxone to treatment centers.

Owen, who used to run a sober house in Boston, said he has heard many stories from recovering addicts and their families about feeling stigmatized or hassled when going to a pharmacy to get naloxone.

“The stigma around naloxone is a cultural thing, and as people understand the disease of addiction more and more, the stigma will be reduced and people will become more likely to request it,” he said.

Joanne Peterson, executive director of the addiction support group Learn2Cope, said she’s not sure how many people struggling with addiction are going to pharmacies for naloxone, but “many family members go to pharmacies to get it if they have a loved one struggling in their lives.”

Having pharmacists proactively offering naloxone, or even just including information about naloxone in prescription bags, could be a helpful way to raise awareness and reduce stigma, she said.

Green said subsequent studies will work to narrow in on potential policy recommendations to reduce stigma.

“A number of pharmacists and patients came up with the idea. What if you offer it to everyone? Then it means nothing. It’s just a policy,” she said. “Naloxone is such an important life-saving medication, we should make it as easy as possible to get.”